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Take this quiz and get a personalized wellness profile with product recommendations and advice that can help you look and feel great and enjoy the good health you deserve. Plus for filling out the Health Questionaire and giving My Herbal Secrets permission to contact you, we will send you a Free Weight Loss Sample Pack with Literature

One Sample Pack per household, limited time offer.
Offer applies to Weightloss Sample Pack Only, with Consultation.
There is a $19.95 shipping and handling fee.

Contact Information

1. Name

Address, City, State, Zip

2. Phone Number / Best Time To Contact ?

Email Address

Eating Habits

1. Which of the following best describes your eating habits?

		A. I eat on the run–fast food, sodas, snacks
		B. I skip breakfast, grab a quick lunch and dinner
		C. I eat several mini meals throughout the day
		D. I eat three balanced meals a day

Weight management

2. How much weight (if any) would you like to lose?

		A. None, I’m already at my ideal weight
		B. Just a few pounds
		C. 10 to 30 pounds
		D. 40 to 100 pounds
		E. More than 100 pounds
		F. None, I want to gain weight

Shape management

3. Where do you tend to store your excess weight?

		A. Mostly around my waist and in my upper body
		B. Mainly in my lower body
		C. All over

Snacking

4. Which of the following best describes you?

		A. I’m a snacker–especially late at night
		B. I tend to snack mid-morning/mid-afternoon
		C. I rarely snack

Activity Level

5. Which of the following best describes your activity level?

		A. I sit, stand and/or drive for most of my day
		B. I am minimally active with housework/ projects
		C. I occasionally work out / take walks
		D. I exercise regularly 3 or more times a week